Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | AA238451 | |
N | 225XP0200X | Occupational Therapist - Pediatrics | AA238451 |
NPI | 1053472787 |
---|---|
Provider Name | Ms. Jill Annette Strandquist |
First Address | Breckenridge, CO 80424 |
Second Address | Breckenridge, CO 80424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0346463 | SP SERVICES LICENSE (01) | CO |
AA238451 | NATIONAL BOARD FOR CERTIF (01) |